CHAD EDWIN JACKSON (NPI# 1518484245) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518484245 |
| Entity Type | Individual |
| Full Name | CHAD EDWIN JACKSON |
| Credential | MS, ATC |
| Practice Address |
14110 Six Mile Cypress Pkwy Fort Myers FL 33912-4314 |
| Mailing Address |
618 Se 3rd St Cape Coral FL 33990-1109 |
| Practice Telephone | 2394796411 |
| Practice Fax Number | 2397682032 |
| Mailing Telephone | 2392927669 |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2017-08-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083S0010X |
Preventive Medicine Specialization: Sports Medicine |
AL2986 | FL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881257178 | Chad Walker Jackson | Social Worker | 7709 Riverview Dr Apt 104, Jenison, MI 49428-7960 | 2019-04-22 |
| 1710177142 | Chad William Jackson | Physical Therapist | 822 S Walnut St, Maryville, MO 64468-2565 | 2007-08-01 |
| 1780772533 | Chad J Jackson | Optometrist | 6575 Belding Rd Ne, Suite D, Rockford, MI 49341-7418 | 2006-10-10 |
| 1255706438 | Chad Jackson | Chore Provider | 2021 40th Ave, Tuscaloosa, AL 35401-3930 | 2015-12-14 |
| 1316329667 | Chad Jackson | Counselor | 3225 1st Ave N, Billings, MT 59101-2104 | 2015-06-23 |
| 1184067498 | Chad Harman Jackson | Ophthalmology | 111 W Main St Ste 200, Boise, ID 83702-7308 | 2013-04-17 |
| 1467773481 | Chad T Jackson | Physician Assistant | 1001 E 2nd St, Coudersport, PA 16915-8161 | 2010-06-14 |
| 1063582120 | Chad M Jackson | Dentist | #5 Eureka Circle, Suite A, Wichita Falls, TX 76308 | 2006-11-08 |
| 1386678191 | Chad Michael Jackson | Specialist | 1747 Medical Center Pkwy, Suite 210, Murfreesboro, TN 37129-2563 | 2006-07-10 |
| Street Address |
14110 SIX MILE CYPRESS PKWY |
| City | FORT MYERS |
| State | FL |
| Zip Code | 33912-4314 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134684814 | Performance Health Surgery Center | Clinic/Center | 9500 Gulf Research Lane, Fort Myers, FL 33912 | 2019-02-06 |
| 1609351899 | Voa Lee County Health Care Facility, Inc. | Skilled Nursing Facility | 14750 Hope Center Loop, Ft. Myers, FL 33912 | 2018-10-03 |
| 1245719954 | Lauren Grimes | Pharmacist | 13711 S Tamiami Trail, Fort Myers, FL 33912 | 2018-08-13 |
| 1972080828 | Solaris Rehab, LLC | Clinic/Center | 14001 Metro Parkway, Fort Myers, FL 33912 | 2018-07-24 |
| 1467943803 | Marie Veronica Scott | Nurse Practitioner | 14015 Danpak Loop, Fort Myers, FL 33912 | 2018-05-22 |
| 1952892291 | Daniels Modern Dentistry, Pa | Dentist | 6871 Daniels Parkway, Suite 100, Fort Myers, FL 33912 | 2018-05-22 |
| 1295258994 | Julie Ann Jakobi | Counselor | 18 Quanery Court, Fort Myers, FL 33912 | 2017-07-25 |
| 1205359908 | Maria Reyes | Developmental Therapist | 8961 Daniels Center Drive Suite 401, Fort Myers, FL 33912 | 2017-07-25 |
| 1669919288 | Darinka Ruiz | Social Worker | 961 Daniels Center Drive, Suite 401, Fort Myers, FL 33912 | 2017-01-20 |
| 1730622598 | Valerie Starnes | Nurse Practitioner | 13411 Parker Commons Blvd Ste 101, Fort Myers, FL 33912 | 2016-11-28 |
| Find all providers in zip 33912 | ||||
| Taxonomy Code | 2083S0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Sports Medicine |
| A preventive medicine physician who specializes in the diagnosis and treatment of sports related conditions and injuries. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760020366 | Eric Peter Reigelsberger | Preventive Medicine | 4657 Main St, Jupiter, FL 33458-5203 | 2019-12-13 |
| 1124247721 | Mark Vincent Walter | Preventive Medicine | 2365 S Tamiami Trl, Sarasota, FL 34239-3808 | 2007-04-24 |
| 1548896434 | Craig John Robinson Wilder | Preventive Medicine | 777 Glades Rd, Boca Raton, FL 33431-6496 | 2020-03-23 |
| 1265068332 | Rachel Leeann Lewis | Preventive Medicine | 777 Glades Rd, Boca Raton, FL 33431-6424 | 2020-03-20 |
| 1922513621 | Hayley Elizabeth Betz | Preventive Medicine | 901 S Flagler Dr, West Palm Beach, FL 33401-6505 | 2017-12-05 |
| 1548541998 | Center for Natural Healing and Regenerative Medicine, Inc. | Preventive Medicine | 2825 N State Road 7, 203, Margate, FL 33063-5737 | 2011-08-30 |
| 1174745806 | Sports Rehabilitation & Physical Medicine Specialists, Inc | Preventive Medicine | 7147 Curtiss Ave, Sarasota, FL 34231-8012 | 2007-05-03 |
| 1215156724 | Advanced Healing Arts | Preventive Medicine | 2365 S Tamiami Trl, Sarasota, FL 34239-3808 | 2007-04-24 |
| 1407072341 | Tiffany B Jordan | Preventive Medicine | 2235 Venetian Court, Suite 1, Naples, FL 34109-8728 | 2007-04-18 |
| City | FORT MYERS |
| Zip Code | 33912 |
Please comment or provide details below to improve the information on CHAD EDWIN JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.